Background: Today, women over 38 years of age are offered foetal diagnostic tests, which are strictly regulated by the Biotechnology Act and must be carried out in an approved institution. Women under 38 years of age must satisfy certain medical criteria in order to be eligible for foetal diagnostic tests. Anxiety is one of the indications that can lead to a woman being offered a foetal diagnostic test.

Aim: The aim of this study was to examine how health care professionals (geneticists and gynaecologists) interpret the terms of the Biotechnology Act with regard to foetal diagnostic tests of early ultrasound to women under 38 years.

Material and methods: The study is based on 6 in-depth interviews with geneticists and gynaecologists at university hospitals, local hospitals and in private practices. The interviews took place from November 2010 to January 2011. The project used qualitative methodology in order to ascertain physicians' experiences and understanding of the law. "Model for the dynamics between demand, supply and consumption of health services" by Frich and Hofmann was used as a framework to uncover factors that influence the consumption of health services.

Results: This study shows that there is agreement at all three levels that the terms of the Biotechnology Act are difficult to relate to prenatal diagnosis, because they are open to broad interpretation. The interviewees express the opinion that early ultrasound should be offered to everyone. In the study, it emerges that the different levels operate with different practices. At the university hospital, anxiety has to be morbid if the patient is to be granted a test, whereas both the gynaecologists at the local hospitals and private practitioners said they did not refuse referrals. At the stage of an early ultrasound, they see the neck fold and nasal bone, but they do not take blood samples. The gynaecologists at the local hospital point out that they do not do foetal diagnostic tests. The women are not referred for genetic counselling before the examination or blood sampling. Gynaecologists do not perceive women as very anxious. There is also a difference in practice between the different university hospitals, where St. Olavs hospital is perceived as liberal and Oslo University as strict.

Discussion and conclusion: Decisions are influenced by a combination of many factors. It is technically easy, and the gynaecologists think it is wrong, not to do the survey. One hospital and one of the gynaecologists in private practice say they want to be certified and must therefore practice. There is an increased demand for an early ultrasound and my study shows that in practice, all women under 38 years can be offered a diagnostic test if they so wish. The Biotechnology Act are going to be revised. There is no evidence that early ultrasound provides health benefits and we need more studies to assess both the economic and prioritizing consequences, before we can introduce an early ultrasound as a public offering